Checkpoint kinase 1 (CHK1) is critical for cell survival under replication stress (RS). CHK1 inhibitors (CHK1i's) in combination with chemotherapy have shown promising results in preclinical studies but minimal efficacy with substantial toxicity in clinical trials. To explore novel combinational strategies that can overcome these limitations, we performed an unbiased high-throughput screen in a non-small cell lung cancer (NSCLC) cell line and identified thioredoxin1 (Trx1), a major component of the mammalian antioxidant-system, as a novel determinant of CHK1i sensitivity. We established a role for redox recycling of RRM1, the larger subunit of ribonucleotide reductase (RNR), and a depletion of the deoxynucleotide pool in this Trx1-mediated CHK1i sensitivity. Further, the TrxR1 inhibitor auronafin, an anti-rheumatoid arthritis drug, shows a synergistic interaction with CHK1i via interruption of the deoxynucleotide pool. Together, these findings identify a new pharmacological combination to treat NSCLC that relies on a redox regulatory link between the Trx system and mammalian RNR activity.

PP2A B55α, encoded by PPP2R2A, acts as a regulatory subunit of the serine/threonine phosphatase PP2A. Despite a frequent loss of heterozygosity of PPP2R2A in cases of non-small cell lung cancer (NSCLC), research on PP2A B55α′s functions remains limited and controversial. To investigate the biological roles of PP2A B55α, we conducted bulk RNA-sequencing to assess the impact of PPP2R2A knockdown using two shRNAs in a NSCLC cell line. Gene set enrichment analysis (GSEA) of the RNA-sequencing data revealed significant enrichment of the epithelial-mesenchymal transition (EMT) pathway, with SNAI2 (the gene encoding Slug) emerging as one of the top candidates. Our findings demonstrate that PP2A B55α suppresses EMT, as PPP2R2A deficiency through knockdown or homozygous or hemizygous depletion promotes EMT and metastatic behavior in NSCLC cells, as evidenced by changes in EMT biomarkers, invasion and migration abilities, as well as metastasis in a tail vein assay. Mechanistically, PP2A B55α inhibits EMT by downregulating SNAI2 expression via the GSK3β-β-catenin pathway. Importantly, PPP2R2A deficiency also slows cell proliferation by disrupting DNA replication, particularly in PPP2R2A−/− cells. Furthermore, PPP2R2A deficiency, especially PPP2R2A−/− cells, leads to an increase in the cancer stem cell population, which correlates with enhanced resistance to chemotherapy. Overall, the decrease in PP2A B55α levels due to hemizygous/homozygous depletion heightens EMT and the metastatic or stemness/drug resistance potential of NSCLC cells despite their proliferation disadvantage. Our study highlights the significance of PP2A B55α in EMT and metastasis and suggests that targeting EMT/stemness could be a potential therapeutic strategy for treating PPP2R2A-deficient NSCLC.

Abstract The replication stress (RS) response protein ataxia telangiectasia and Rad3-related protein (ATR) and its main downstream factor, checkpoint kinase 1 (CHK1), play important roles in cell survival under RS. The inhibitors targeting CHK1 (CHK1i’s) have been shown to be a powerful strategy for treating solid tumors and hematological malignancies in preclinical studies. However, in most clinical trials, including those for treating non-small cell lung cancer (NSCLC), which accounts for 85% of all lung cancer cases, CHKi’s have failed to achieve their primary endpoints and have shown cumulative tissue toxicities in normal tissues. These findings significantly limit the clinical benefit of these agents. Thus, identifying novel combinational strategies that can enhance the sensitivity of tumor cells to CHKi’s, while limiting their toxicities, might be the key to improve the safety and efficacy of these compounds. To explore novel combinational strategies that can overcome these limitations, we performed an unbiased high-throughput screen in a NSCLC cell line and identified thioredoxin1 (Trx1), a major component of the mammalian antioxidant-system, as a novel determinant of CHK1i sensitivity. We established a role for redox recycling of RRM1, the larger subunit of ribonucleotide reductase (RNR), and a depletion of the deoxynucleotide pool in this Trx1-mediated RS. In addition, we also demonstrate that CHK1-mediated E2F1-RRM2 induction was triggered during Trx1 or TrxR1 depletion-induced RS. CHK1 inhibition abrogates the Trx1 or TrxR1 depletion induced RRM2 expression and leads to the more profound dNTP pool scarcity. Further, the TrxR1 inhibitor auronafin, an anti-rheumatoid arthritis drug, shows a synergistic interaction with CHK1i via interruption of the deoxynucleotide pool. In summary, our study reveals an underappreciated mechanism responsible for the Trx or TrxR1 inhibition-induced RS. We propose that increased RRM1 oxidation following Trx system inhibition and the abrogation of RRM2 pathway by CHKi contributes to the synergistic interaction by the severe loss of RNR function. Our findings identify a new pharmacological combination to treat NSCLC that relies on a redox regulatory link between the Trx system and mammalian RNR activity. Citation Format: Chandra Bhushan Prasad, Adrian Oo, Zhaojun Qiu, Na Li, Deepika Singh, Xiwen Xin, Young-Jae Cho, Zaibo Li, Xiaoli Zhang, Chunhong Yan, Qingfei Zheng, Jimin Shao, Qi-En Wang, Baek Kim, Junran Zhang. The thioredoxin system determines CHK1 inhibitor sensitivity via redox-mediated regulation of ribonucleotide reductase activity [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: DNA Damage Repair: From Basic Science to Future Clinical Application; 2024 Jan 9-11; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2024;84(1 Suppl):Abstract nr B024.